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Liver Function Tests

Alkaline Phosphatase

February 15th, 2021


Alkaline phosphatase (ALP) is an enzyme normally found in liver, bone, intestine, late placenta and kidney. Its elevation is often used to diagnose cholestatic liver dysfunction, though it may also be elevated in bone disease as well as certain other conditions.
    • Normal Range

    • 35 - 100 U/L
  • Significance

  • ALP is used as a marker of cholestasis, though may also be raised in the setting of certain non-hepatic conditions.
ALP and GGT may also be mildly elevated in the presence of hepatocellular disease, with predominant derangement of the transaminases.

Cholestatic LFT Derangement

  • Look For

  • Elevated ALP and GGT
  • Mildly elevated ALT / AST
  • Elevated conjugated bilirubin
  • Causes of Cholestasis

  • Intrahepatic Cholestasis

  • Hepatitis (viral or alcoholic)
  • Autoimmune liver disease - primary biliary cirrhosis, primary sclerosing cholangitis
  • Infiltrative liver disease - amyloidosis, sarcoidosis, tuberculosis, lymphoma
  • Malignancy - hepatocellular carcinoma, cholangiocarcinoma, metastasis
  • Non-malignant mass - abscess, cystic liver disease, haematoma
  • Sepsis
  • Acalculous cholecystitis
  • Intrahepatic cholestasis of pregnancy
  • Total parenteral nutrition
  • Drugs - augmentin, isoniazid, rifampicin, chlorpromazine
  • Extrahepatic Cholestasis

  • Choledocholithiasis
  • Bile duct stricture
  • Parasitic infection of bile duct
  • Primary sclerosing cholangitis
  • Pancreatitis
  • Pancreatic cyst
  • Malignancy - pancreas, ampulla, common bile duct, gallbladder

Isolated ALP Elevation

  • Significance

  • Suggestive of a non-hepatobiliary cause.
  • Causes of Isolated ALP Elevation

  • Bone pathology - fracture, osteomyelitis, osteomalacia / Ricket's, bony metastasis, Paget's disease
  • Rapid bone growth (adolescents)
  • Late pregnancy
  • Hyperthyroidism
  • Congestive cardiac failure
  • End stage renal failure
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